Presession mood induction in therapists: Effects on therapist empathy

Previous studies show that therapist mood is associated with psychotherapy processes, but the observational nature of these studies does not allow for causal inference. It is also unclear if other therapist characteristics, such as therapist trait empathy, moderate the relation between therapist mood and process variables. Thirty-four therapists and volunteer client dyads participated in three weekly counseling sessions. Before each session, therapists were induced to experience one of three moods, elation, depression, or neutral, in a counterbalanced order, using a combination of music and the Velten method. After each session, clients rated therapist empathy and session quality, therapists rated session quality, and observers rated therapist empathy using videotapes. Electrocardiogram was collected from therapists and clients during the session to assess heart rate synchrony as an indicator of therapist empathy. Therapist trait empathy moderated the effect of mood induction on observer-rated therapist empathy, such that when induced to experience elation, therapists with high trait empathy were observed to be more empathic, whereas therapists with low trait empathy were observed to be less empathic. Therapists of different trait empathy levels did not differ on observer-rated empathy when induced to experience depression or neutral mood. No significant effect of mood induction was found for client-rated empathy, client- and therapist-rated session quality, or heart rate synchrony. The experimental design offers preliminary evidence that therapist presession mood may influence the psychotherapy process. The findings are explained in light of empathy amplification and empathy attenuation hypotheses in relation to positive emotion. Practice and research implications are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A curvilinear association between therapists' use of discourse particles and therapist empathy in psychotherapy

This study investigates the relationships between therapists' use of discourse particles and therapist empathy. Discourse particles, commonly found in non-English languages, are verbal elements that constitute metacommunication by encoding speakers' emotions and attitudes, which are typically expressed by nonverbal behaviors (e.g., intonation, tone, facial expression, nodding). We hypothesize an inverted U-shaped curvilinear relationship between therapists' use of discourse particles and therapist empathy, given the notion that an optimal level of therapists' emotion in psychotherapy can facilitate clients' inner experiencing and self-expression. Four psychotherapy sessions each from 39 therapist-client dyads were analyzed. After each session, therapist empathy was rated by trained observers using the Therapist Empathy Scale (TES) and by clients using the Barrett-Lennard Relationship Inventory (BLRI). Multilevel modeling shows that both the person-level negative quadratic term and positive linear term for therapists' usage of discourse particles are significant in predicting mean TES with large effect sizes. The same predictors do not yield significant results in predicting mean BLRI but they trend in similar directions of associations with medium effect sizes. Our results suggest the optimal usage of discourse particles by therapists is around 20.3% (out of all utterances). The nonsignificant results in BLRI may be attributed to the relatively small sample size of our data and the noncommunication orientation of the client-rated measure. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Referring students for professional psychological help: A qualitative study of teachers' experience in Hong Kong

Teachers have frequent interaction with students and are well positioned to refer students for mental health assistance when needed. Twelve secondary schoolteachers in Hong Kong were interviewed about their experience referring students to mental health professionals (MHPs). Using consensual qualitative research, multiple factors were found to influence teachers' referral decisions, including problem severity, students' willingness, stigma of help-seeking, parent/guardian's beliefs, teacher-parent/guardian relationship, MHPs' effectiveness and availability, quality of interaction with MHPs, and teachers' self-efficacy in handling student issues. Based on the findings, we propose a conceptual model of factors influencing teachers' referral decisions. Implications for research, practice, and training are discussed.

Therapist emotion and emotional change with clients: Effects on perceived empathy and session quality

Therapists' emotion and therapist-client emotional congruence are associated with psychotherapy process and outcome. However, their presession emotional states are not consistently accounted for across studies, and the underlying mechanism is unclear. This study introduces the concepts of directional correspondence (DC), where therapists' and clients' emotions move in a similar direction from pre to postsession, and absolute agreement (AA), where therapist and client become closer in emotions from pre to postsession, to examine congruence in emotional change in therapist and client from pre to postsession. In addition, clients' perception of therapist empathy was investigated as a mediator between therapists' emotion/therapist-client emotional congruence and session outcome. Sixty nine clients and 49 therapists participated in this study over the course of therapy (593 sessions in total). They rated their emotions before and after each session, and clients rated therapist empathy and session quality after each session. Multilevel models showed that therapist presession emotions, therapist-client presession emotional similarity, and DC did not predict therapist empathy and session quality. However, AA predicted better therapist empathy, which in turn predicted better session quality. The partial mediation path was also stronger when therapist and client had more dissimilar presession emotions. Thus, clients may rate a session based on their perception of therapist empathy, which may reflect therapist and client moving toward more similar emotions over a session. In addition, the positive effect of therapist and client growing closer in emotions is especially pronounced when they start sessions in different emotional states. Implications of the findings are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Formality in psychotherapy: How are therapists' and clients' use of discourse particles related to therapist empathy?

INTRODUCTION

Previous studies explored the preferences for therapists' attire and office setting based on initial impressions as a reference for the formality in psychotherapy. This study examines the formality of psychotherapy by investigating therapists' and clients' use of discourse particles, the linguistic marker and quantifier of the formality in speech, in relation to therapist empathy in different stages of psychotherapy.

METHODS

Four psychotherapy sessions (representing early, mid, and late stages) each from 39 therapist-client dyads were analyzed. Trained observers rated therapist empathy in each session using the Therapist Empathy Scale.

RESULTS

Results of multilevel modeling show that synchrony in particle usage, hence synchrony in formality, between clients and therapists is not associated with therapist empathy. Therapists' use of particles (i.e., absolute formality of therapists) was also not associated with therapist empathy. In contrast, the relative formality of therapists plays significant roles: therapist empathy is generally observed when therapists are relatively more formal than the clients (i.e., lower relative usage of particles by the therapists when compared to the clients). However, for clients who speak formally with few particles, therapist casualness (i.e., higher relative usage of particles than the clients) at the beginning of therapy may be interpreted as therapist empathy as therapists help these clients ease into the therapeutic relationships.

DISCUSSION

Our results suggest that the examination of therapists' and clients' use of particles across different stages of treatment may illuminate dynamic interactional styles that facilitate or hinder the psychotherapy process.

Does peer relationship matter? A multilevel investigation of the effects of peer and supervisory relationships on group supervision outcomes

Research in clinical supervision has primarily focused on the contribution of supervisors to training outcome. However, peers may also play a significant role in trainees' development, particularly during group supervision. Fifty-three trainees from 10 supervision groups completed measures of peer relationship, supervisory working alliance (SWA), supervision satisfaction (SAT), and counseling self-efficacy (CSE) at three time points during a 20-week counseling practicum at a department clinic in Hong Kong. Multilevel modeling was conducted to test the hypothesis that both peer relationship and SWA contribute to SAT and CSE. The path model results showed that higher within- and between-trainee SWA was associated with higher SAT, and higher between-trainee SWA was associated with higher CSE. Better within- and between-trainee peer relationship was associated with higher CSE, but not with SAT. Thus, when peer relationship and SWA were entered as predictors into the same analysis and allowed to control for each other's effects, they each have unique contributions to the outcome of group supervision. Implications for training and supervision research are discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Refractive outcome of combined phacoemulsification and endoscopic cyclophotocoagulation

PURPOSE

To compare the refractive outcome of eyes that underwent phacoemulsification combined with endoscopic cyclophotocoagulation (phaco-ECP) with the eyes that underwent phacoemulsification alone.

METHODS

A retrospective case series review of 103 consecutive eyes that underwent phaco-ECP and 62 eyes that underwent phacoemulsification between January 2006 and August 2012 was conducted. Post-operative refractive outcomes were obtained by subjective refraction or autorefraction. Demographic data, best corrected visual acuity, intraocular pressure, number of glaucoma agents and mean deviation of the Humphrey visual field test (MD) were also analysed.

RESULTS

The total number of eyes included in the study was 62 eyes for the phaco-ECP group and 62 eyes for the control group who underwent phacoemulsification alone. More than 90% of eyes (n = 56) in phaco-ECP group achieved post-operative refraction within ±1 dioptre (D) of the target refraction. In the control group, 100% of eyes achieved post-operative refraction within ±1D of the target refraction. When comparing the difference between the target and the actual refractive outcome between the phaco-ECP and the control group, there was no statistically significant difference.

CONCLUSIONS

Refractive outcome after phaco-ECP is comparable to phacoemulsification alone. This study suggests that the intraocular lens power can be selected for cataract surgery alone and that ECP does not change the effective lens position significantly; therefore, no modification of biometry formulae is required. Phaco-ECP should be considered as an effective, safe and predictable surgical treatment option for glaucoma patients with co-existing cataract.

Hong Kong experiences the 'Ultimate superbug': NDM-1 Enterobacteriaceae

We report the second imported case of New Delhi metallo-beta-lactamase (NDM-1) Enterobacteriaceae encountered in Hong Kong soon after the patient's arrival in the territory for medical care. As NDM-1 is spreading throughout the world via international travel, being an international city, Hong Kong was always expected to encounter the same public health threat. This case also illustrates the importance of active surveillance of at-risk patients in preventing the spread of this 'superbug'.

Diagnostic challenges of human brucellosis in Hong Kong: a case series in two regional hospitals

A retrospective analysis of six patients diagnosed with brucellosis in two regional hospitals was carried out. The epidemiological, clinical, and laboratory features were studied. All patients had exposure history. Three patients presented with musculoskeletal symptoms, while three had predominantly genitourinary symptoms. One patient did not have fever at presentation. All patients were diagnosed by positive blood culture of Brucella melitensis, and the diagnosis was not suspected for all except one patient at presentation. Given the inferior sensitivity of blood culture to serology, human brucellosis may be underdiagnosed, especially when the index of suspicion is low.

Prehospital blood transfusion versus crystalloid alone in the air medical transport of trauma patients

INTRODUCTION

Differences in prehospital resuscitation measures and outcomes of trauma patients transported by two air medical programs were assessed comparing the prehospital administration of crystalloid only (Group A) with the administration of 2 liters of crystalloid followed by blood (Group B).

METHODS

A 1-year retrospective review of flight and hospital records of patients taken to Level I trauma centers by two separate air medical programs was completed. Physiologic variables, total fluids infused, and flight times were compared.

RESULTS

Thirty-one patients (Group A) received crystalloids in flight, and 17 patients received in-flight blood (Group B). No statistical differences were found between the two groups when comparing age, ISS, PS, RTS, GCS, survival, and total fluid volume. Group B had statistically greater mean flight times compared with Group A (P < .05). A difference was demonstrated between groups A and B in pH and HCO3 measurements (P < .05), with Group B presenting in a more acidotic state on admission to the hospital.

CONCLUSION

Patients with lengthy flight times, despite the administration of blood products, presented to the trauma center more acidotic than trauma patients receiving only crystalloid. The true impact of blood products on outcome could not be demonstrated because of statistical differences in flight times between the groups. A multicenter study matching flight times, head injury status, and flight type of assess benefit of prehospital utilization of blood products is warranted.

Selective hepatic arterial embolization of grade IV and V blunt hepatic injuries: an extension of resuscitation in the nonoperative management of traumatic hepatic injuries

BACKGROUND

Recognizing the significant mortality and complications inherent in the operative management of blunt hepatic injuries, hepatic arterial embolization was evaluated as a bridge between operative and nonoperative interventions in patients defined as hemodynamically stable only with continuous resuscitation.

METHODS

Seven of 11 patients with grade IV or V hepatic injuries identified by computed tomography underwent hepatic arterial embolization. A prospective evaluation of hepatic embolization based on subsequent hemodynamic parameters was assessed by matched-pair analysis. A summary of this study population's demographic data and outcomes is presented, including age, Glasgow Coma Scale score, Injury Severity Score, Revised Trauma Score, computed tomography grade, intensive care unit and hospital length of stay, transfusion requirements, complications, and mortality.

RESULTS

No statistical difference was demonstrated between pre-embolization and postembolization hemodynamics and volume requirements. After embolization, however, continuous resuscitation was successfully reduced to maintenance fluids. Hepatic embolization was the definitive therapy for all seven patients who underwent embolization.

CONCLUSION

Results of this preliminary investigation suggest that hepatic arterial embolization is a viable alternative bridging the therapeutic options of operative and nonoperative intervention for a subpopulation of patients with hepatic injury.

Clinical analysis of the utility of repeat computed tomographic scan before discharge in blunt hepatic injury

OBJECTIVES

Nonoperative management of hemodynamically stable blunt hepatic injury has emerged as an acceptable and safe treatment. Surveillance of this population's injuries is costly. As a prelude to establishing practice guidelines, the utility of repeat computed tomographic (CT) scans was investigated.

METHODS

A retrospective study was conducted on 243 hepatic injuries. The CT scans of 95 patients managed nonoperatively who did not have ongoing transfusion requirements were reviewed and graded according to the American Association for the Surgery of Trauma (AAST) hepatic injury scale. Patients were grouped according to injury grade, assigned to two subgroups (patients with one CT scan versus more than one CT scan) and compared with respect to several physiologic and clinical variables.

RESULTS

Statistical analysis revealed no significant difference between subgroups with the same grade of injury. No significant difference was demonstrated between subgroups' length of stay.

CONCLUSIONS

No patients failed nonoperative treatment or succumbed to their injuries. Findings on repeat CT scan have not altered the decision to discharge the clinically stable patient having suffered a grade III or lower liver injury.

Adverse interaction between warfarin and indomethacin

A 57-year-old man developed spontaneous skin bruising and haematuria during combined therapy with warfarin and indomethacin. Due to the potential effects of nonsteroidal anti-inflammatory drugs (NSAIDs) on the anticoagulant action of warfarin and platelet function, patients receiving both warfarin and NSAIDs should have their prothrombin time monitored very closely. Also, the risk of gastrointestinal haemorrhage with any NSAIDs must always be remembered.

Significance of silent myocardial ischemia during exercise testing in patients with coronary artery disease

To evaluate the significance of ischemic ST-segment depression without associated chest pain during exercise testing, data were analyzed from 2,982 patients from the Coronary Artery Surgery Study (CASS) registry who underwent coronary arteriography and exercise testing and were followed up for 7 years. Patients with proved coronary artery disease (CAD) (at least 70% diameter narrowing) were grouped according to whether they had at least 1 mm of ST-segment depression or anginal chest pain during exercise testing. Four hundred twenty-four had ischemic ST depression without angina (group 1); 232 had angina but no ischemic ST depression (group 2); 456 had both ischemic ST depression and angina (group 3); and 471 had neither ischemic ST depression nor angina (group 4). Sixty-three percent of patients in group 1 and 55% in group 2 had multivessel CAD (difference not significant). The 7-year survival rates were similar for patients in groups 1 (76%), 2 (77%), and 3 (78%), but were significantly better for patients in group 4 (88%, p less than 0.001). Among group 1 patients, survival was related to severity of CAD (p less than 0.001). The 7-year survival rate in group 1 was significantly worse than that in a separate group of 282 patients with ischemic ST depression without angina during exercise testing who had no CAD (95% survival, p less than 0.001). Thus, in patients with silent myocardial ischemia during exercise testing, the extent of CAD and the 7-year survival rate are similar to those of patients with angina during exercise testing. Prognosis is determined primarily by the severity of CAD. In patients without CAD, the survival rate is excellent.

Hürthle cell tumor behavior: dilemma and resolution

Thirty-four patients with the diagnosis of Hürthle cell tumor occurring from 1971 to 1984 were reviewed to help delineate an acceptable treatment policy. Twenty-nine of these occurred in the last 5 years of study so that extensive follow-up was not possible. Patients varied from age 17 years to 82 and consisted of five males and 29 females, most of whom had an asymptomatic solitary cold nodule. There was a 26% incidence of malignancy. One patient died of cancer caused by anaplastic change of underlying disease; this woman had refused surgery after an incisional biopsy specimen showed benign Hürthle cell tumor. Surgery consisting of lobectomy in 16 patients and near-total thyroidectomy in 18 was uncomplicated. No nodal surgery was necessary. Eighteen percent of patients had multicentric disease of which one half were malignant. Twelve percent of patients developed contralateral Hürthle cell tumor after lobectomy. Associated thyroid lesions occurred in 30% of patients, hyperparathyroidism in 10%. There are polar views in the literature on the management of these patients. While our own tumor experience has been reassuring, we feel that in view of the paucity of cases, those who view this tumor in a serious light deserve attention. Accordingly we advocate near-total thyroidectomy as a primary operation for those who are fit, lesser procedures for the disabled, and the difficult situation, and node sampling to detect early metastasis and improved survival in this group. It is apparent that further reporting of long-term follow-up experience is necessary for complete resolution of dilemmas in the treatment of this problem.

A comparison between cyclosporin A and methylprednisolone plus azathioprine on bronchial healing following canine lung autotransplantation

The effects of two low-dose immunosuppressive therapies upon the healing of the bronchial anastomosis and skin wounds following lung autotransplantation were evaluated. Autotransplantation was performed in three groups of dogs: Group 1 (nine dogs) received no immunosuppression, Group 2 (seven dogs) received postoperative immunosuppression with methylprednisolone (2 mg/kg) and azathioprine (1.5 mg/kg), and Group 3 (four dogs) received postoperative immunosuppression with cyclosporin A (20 mg/kg/day). Skin incisions 7 cm in length were made in the dorsal region of each dog. Dogs were put to death 23 days postoperatively, and the breaking strength of the bronchial anastomoses and skin wounds was evaluated with the Instron Universal Testing Machine, with a cross-head speed of 0.5 cm/min. Bronchial breaking strengths were similar in Groups 1 and 3 and significantly higher than in Group 2 (p less than 0.001). Skin breaking strengths were similar in Groups 1 and 3 and significantly higher than in Group 2 (p less than 0.001). Scanning electron microscopic (SEM) studies of both skin and bronchial wounds showed normal formation of collagen bundles in Groups 1 and 3 but a disorganized pattern in Group 2. Our results suggest that low-dose immunosuppression with methylprednisolone and azathioprine significantly affects wound healing and breaking strength of both bronchial anastomoses and healed skin incisions following canine lung autotransplantation. Immunosuppression with cyclosporin A had no adverse effect on either bronchial or skin healing.